More than a Picky Eater?

More than a Picky Eater: How to Really Know?

Boy with ice cream

The struggles of a parent during mealtime with a picky eater can range from bad to worse. It often begins with the ever-present protest of “No!” then ends with screaming, tantrums and food flying across the room. The question remains: is the food refusal normal of a picky eater or could the signs be more consistent with a feeding disorder?

A pediatric feeding problem is often accompanied by a developmental delay or medical disorder. These can include, but are not limited to, autism spectrum disorders, Down syndrome, gastrointestinal motility disorders, cerebral palsy, respiratory disorders or cystic fibrosis.

Children who were hospitalized for an extended time at birth or who received a tracheotomy or feeding tube may also have difficulty transitioning to an age appropriate feeding pattern. However, children who are considered typically developing can also develop a fear of food. Research shows that 25 percent of children suffer with some degree of a feeding disorder. In children who suffer from a developmental, neurological or genetic disorders, that number rises to 80 percent (Branan & Ramsey, 2010).

A feeding disorder is characterized by any difficulties eating or drinking including chewing, sucking or swallowing. Children who have not developed age appropriate feeding skills and/or have a genetic, developmental or behavioral disorders can have difficulty during mealtime.

Some signs and symptoms of a problem feeder include:

  • Trouble breathing when eating or drinking
  • Choking, gagging or excessive crying during mealtimes
  • Tantrums when presented with new foods
  • Excessive drooling or spillage of foods/liquids from the mouth
  • Difficulty chewing or swallowing food
  • Restricted variety of foods eaten—usually less than 20
  • Refusal of categories of food based on texture or basic food group
  • Refusal to eat meals with the family

In order to better treat children with feeding problems, it is important to understand those children who do not meet the criteria. Children who are picky eaters present with the following signs and symptoms (Toomey 2010; Arvedson 2008):

  • Eat a limited variety of foods; but have around 30 foods they will eat
  • Intake enough calories a day for growth and nutrition
  • Lose interest in a certain food for a period of time, but accept it again after a few weeks
  • Eat at least one food from all major food groups (protein, grains, fruits, etc.)
  • Tolerate a new food on the plate, even if they don’t eat it

Although mealtimes with either issue can be difficult for parents, distinguishing between the two helps SLPs create the best individualized treatment approach.

Once a professional diagnoses a child with a feeding disorder, there are three key concepts to remember:

1. Contact a child’s pediatrician, nutritionist and other health care providers in order to create the best treatment plan for that child. A multidisciplinary approach provides various viewpoints that bring the whole child into consideration.
2. Choose foods that are meaningful to the family. If no one else in the family eats broccoli, it may not be a necessary food to add to the child’s eating repertoire.
3. Create both short term and long term goals to track progress and keep both the child and family motivated.
Treating a child with a feeding disorder is a challenging but rewarding task. The end goal of treatment should always be a safe, happy and healthy eater.

April Anderson, MA, CCC-SLP, is a Speech-Language Pathologist at National Speech/Language Therapy Center in Bethesda, MD. She works with infants and toddlers, as well as school-aged children with feeding disorders. April can be reached at